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In a very few industries you get one organisation which becomes to all intents and purposes synonymous with the product involved such that the name of that organisation comes to mean the same thing as the product, entrenched in people's minds as the product. Hoover is the most obvious example, being shorthand for the vacuum cleaner.

Another example is BUPA, where for many people the word means private medical insurance (PMI) and there is nobody else involved.

Usually, the organisation gets to be that way because of high product quality, exceptional customer service or simply being the best at what they do. Now that certainly isn't the case and BUPA only got to be the best known provider of PMI because for many years it was virtually the only provider and had an absolute monopoly.

Let's go through the history...

BUPA was formed in 1947 by the amalgamation of a number of provident not for profit associations, following the creation of the NHS. The name itself describes it and stands for the British United Provident Association. The optimism of those well meaning individuals forming the NHS that the UK's total healthcare needs could be centrally provided proved to be ill founded and the 1970's and 1980's saw the PMI industry grow rapidly in size, with BUPA predominant. In 1980, BUPA had 70% market share.

However, a number of factors led to the gradual erosion of this dominance, and by the end of the decade market share had fallen to around 40%. BUPA still held by far the largest share, but could not exercise its previous degree of influence.

The BUPA Group consists of three operating divisions. The original UK PMI provider, BUPA Membership Division, is still the mainstay of the organisation and the largest division. The other two parts are BUPA Hospitals and BUPA International. BUPA Hospitals provides private healthcare facilities in the
UK, such as private hospitals, medical centres and nursing homes. BUPA International consists of a series of international operations which offer both insurance and healthcare in such former British colonies as Malta, Hong Kong, and Gibraltar, with a large wholly owned subsidiary in Spain.

Both of these other two divisions are a massive drain on central resources. BUPA Hospitals' development entailed heavy expenditure on purchasing and building hospitals and BUPA International required significant initial funding. A greater drain, however, was the degree of managerial attention demanded.

BUPA grew complacent, feeling market dominance was a divine right. The largest competitor, PPP, had a small but growing market share, but was considered insignificant, as were other competitors. The management time required by the other divisions, together with complacency and arrogance, led to the BUPA Group taking its eye off the ball in the 1980's and devoting insufficient attention to PMI.

PPP was competing aggressively, directly against BUPA and it proved easy to steal business. At the same time, other smaller competitors were starting to eat into BUPA's market share. They were flexible enough to capitalise on the weaknesses of what was becoming an inert, bureaucratic monster. More worrying, however, were the larger composite insurers like Norwich Union, who were developing plans for entry to an overtly profitable industry. This combination was potentially lethal for BUPA.

BUPA undertook a massive investment in new computerised administration systems in 1986-88, contracting an American company called EDS to provide a systems solution. The system developed was known as BASS and became the straw that nearly broke the camel's back.

EDS' knowledge and systems had been built up in the States and proved ill suited for the UK. Initial cost and time estimates were hopelessly inadequate and in the end almost £100m was sunk in the project. The software was written in outdated programming language and difficult to modify. The EDS contract caused problems with BUPA's own IT function. They objected strongly to the decision to go outside for the system and contended that they should develop it in house. When responsibility for maintenance and development transferred to the internal function, they were reluctant to accept ownership. It proved almost impossible to modify BASS. It became a standing joke internally that any system change would require man years of programming time even when possible.

In order to capitalise on the systems investment, the Managing Director changed BUPA's organisational structure. Previously it had consisted of a Head Office plus 14 nationwide branch offices dealing with customer enquiries, membership, claims and sales. The branches operated as autonomous units, managed their portfolio of business in the way they deemed best and developed individual operating practices.

The branches identified closely with their customers and aimed for a personal, caring image. However, a wide divergence of operating practices developed and there was no responsibility for profit. Financial control was inadequate and many customers were getting a level of service far in excess of that for which they were paying.

It was decided to end this state of affairs, introduce profit responsibility and reduce operating costs. Responsibility for admin was transferred to three new Business Centres, each serving one of BUPA's market segments. However, the branches were retained and this proved to be a key problem.

Many roles within the branches were made redundant. At the same time, teams of newly recruited Business Centre staff visited the branches to load manually maintained membership records on the new system. This caused much internal resentment and disaffection.

Inevitably, there were unforeseen difficulties and delays in implementing the new system and it was left to staff in the branches to make excuses to customers for the problems. This was a natural reaction but led to further problems between branches and Business Centres which inevitably impacted negatively on customers.

The debacle set BUPA back years, and they spent the next decade trying to paper over the cracks that had developed, with the new system becoming a beast to be fed rather than a major strategic advantage. Millions were spent on costly reorganisations and wasted on fruitless organisational change programmes with a multitude of management consultants and because the focus was very inwardly focused, they screwed up completely in terms of helping the customers.

I know all this because I spent the years between 1988 and 1996 working for this bureaucratic nightmare.

Okay sorry, about that lengthy history lesson, but I thought it would be useful to give you the background. What all of it means is that BUPA has spent the last ten years in reactive, follow the leader attempts to recover the high ground and have lost their market standing.

PMI policies have become more and more expensive and less and less comprehensive, such that these days there is little reason to take them out. You could usually buy the care you wanted for the same cost as your premiums by going private and BUPA do not cover emergency care, which is still far better provided by the NHS. All sorts of excesses and exclusions have been introduced to try and keep prices down and all you are actually buying when you fork out your hundreds to BUPA each year is a very poor insurance policy which is relatively worthless.

Don't be fooled by the caring image and the semi professional approach - BUPA are a bunch of cowboys whom you cannot trust - I know, I used to be the one wearing the spurs...

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